Class notes for Older Adult Exam 1 Flashcards
Is geriatrics or gerontology disease focused?
geriatrics. gerontology is holistic improvement of health
life expectancy today in the US
78.5
biological maximum length of life that can be achieved under the right circumstances
life span
Years of Productive Life
- good outlook on life
- concentration on diet, exercise, decrease in smoking
- advances in technology
- SES
- flu shots, yearly doctor visits, CAM therapies
Compression of mortality
We want people to be more or less healthy for a longer period of time
Extreme seniors
individuals who continue to be active into their older years e.g. skydiving, motorcycles etc.
“spending down”
go through all assets, for an individual needs to keep $1500 everything else needs to be sold and given away until you are considered for medicaid - all of life savings must be spent
Communication barriers with the elderly
fear of one’s own aging, fear of showing emotion or being around emotional patients, fear of missing something and needing to write it down, lack of knowledge of patient’s culture, goals, values, unresolved issues (p.51)
What factors are considered important to the gerontological nurse?
health mgmt, nutrition, elimination, activity and sleep, cognition and self perception, role, sexuality, values and beliefs, coping and stress (p.52)
3 examples of IDL’s
Driving, cooking, writing a check
Rolling assessment
Targets at least 1 domain each visit - older adults are usually getting monthly check-ups so a rolling assessment is looking at one screening component each visit is very helpful.
Concerns for the elderly
fear of death institutionalized loss of independence not being able to afford to be healthy pets being forgotten embarrassment-a burden afraid to go to bed bc scared they won’t wake up in morning
Tetanus booster (every 10 years) and cholesterol screenings (every 5 years) are considered
primary prevention (p.74)
Colonoscopy is recommended every _____ years and is considered secondary prevention
5-7 years
OBRA87
requires all states to operate long-term care ombudsmen programs and to notify patients about their rights - residents of homes can make complaints about violation of rights. Aim to limits use of physical and chemical restraints, informed consent/decisional capacity, advanced directives (p.75)
Major safety considerations
lighting adequate on stairs? stair rails? nonskid surfaces on stairs? throw rugs? crowded living room? tub rails, non slip? space heaters present? refrigeration and food ok? medications properly labeled? toxic substances away from food? home adequately ventilated and heated? safe neighborhood? fire/police notified of older person in home? (p.409)
Conductive hearing loss
sound unable to transmit to inner ear, amplification problems
Sensorineural hearing loss
noise-induced hearing loss, harder time with higher pitches
Which is a bigger concern? Conductive hearing loss os sensorineural hearing loss?
Sensorineural
Bilateral hearing loss may be due to
loud noises affect both sides, lack of cilia, sagging auricle, cerumen harder and drier
Weber test
quick screening test for hearing. It can detect unilateral (one-sided) conductive hearing loss (middle ear hearing loss) and unilateral sensorineural hearing loss (inner ear hearing loss).
Rinne test
compares air- and bone-conduction hearing. Air-conduction hearing occurs through air near the ear, and bone-conduction hearing occurs through vibrations.
When speaking with a hearing impaired individual one should….
eliminate extraneous noise, stand 2-3 feet from patient, have patients attention before speaking, try to LOWER pitch of voice, pause at the end of each sentence, provide assistance with hearing device, make sure the patient can see you, do not cover your mouth or chew gum because some may lip read, speak slowly and clearly, gestures can help, written communication, ask the patient for an oral or written response to see if it was successful
What do elderly people want when experiencing hypogeusia (diminished taste)?
sweet and salty foods
1 problem for xerostomia (dryness of mouth)?
medications
Elderly need approximately this amount of water/day?
1500 ml
Reasons for decrease intake of water?
Do not/can not request
Visual impairment
Cannot reach
Predisposition dehydration
Sundown Syndrome
agitation as sun goes down, may become violent, family members can help, routine can help, keeping light on in the room can help, helps decrease falls with the light, shadows can get scary sometimes
1st sign of infection for elderly?
CONFUSION. #1 = UTI #2 = RESPIRATORY INFECTION
Sample pain interview questions (Box 9-3) p. 270
Pain hx, distinguish between acute/chronic pain, location, freq., intensity, alleviating/aggravating factors, associated symptoms, response to current pain meds, meaning of pain
If the body doesn’t adjust in 48 hours the sleepiness is not due to the pain med this could mean
end of life issues
Start low and
go slow with pain meds - can cause respiratory depression
Older adults 65+ should have their vision checked
every 1-2 years
Response time for recovering from glare or moving from outdoors to indoors (also known as dark adaptation) is
longer for the older adult. This may be
a key time when the older adult is at a significant risk of
falls
50% of adults in the US over 80 have had
cataracts or surgery to remove a cataract
Two types of ARMD include
dry and wet. The wet version is more severe and can lead to a quicker progression of visual loss.
Suggestions for improving access to healthcare for the elderly
- improve health insurance coverage
- outreach services
- case mgmt care
- cultural competence and communication
- improve transportation services
